Healthcare Provider Details

I. General information

NPI: 1790259315
Provider Name (Legal Business Name): REDBRICK MENTAL HEALTH &THERAPY GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 FOREST HILL BLVD STE 203
WEST PALM BEACH FL
33406-5878
US

IV. Provider business mailing address

3540 FOREST HILL BLVD STE 203
WEST PALM BEACH FL
33406-5878
US

V. Phone/Fax

Practice location:
  • Phone: 561-252-1952
  • Fax:
Mailing address:
  • Phone: 561-252-1952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN C. HEELAN
Title or Position: MGR
Credential: PHD,LMHC
Phone: 561-252-1952